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THE PHARYNX AND NASOPHARYNX
orbit will give rise to proptosis. Most tumours are proliferative in type and
cause downward displacement of the soft palate. The tumour may metastasize
early to the upper deep cervical lymph nodes.
SYMPTOMS. The symptoms vary greatly according to the direction of spread.
Profuse epistaxis or bloodstained nasal discharge may occur early, or
unilateral conductive deafness, often with middle ear effusion, may be the
first symptom. An enlarged firm upper cervical lymph node may appear even
before there is a visible tumour mass in the nasopharynx. The spread to
involve cranial nerves has been described, as has metastases to glands.
CLINICAL FEATURES. Any of the symptoms described should lead to a
careful examination of the nasopharynx, which is often best done, under a
general anaesthesia, through a nasopharyngeal speculum. If the tumour is
obvious a piece is removed for biopsy, but if there is no obvious tumour a
biopsy should be taken from the nasopharyngeal roof or from the region
behind the opening of the auditory tube on the side of the presenting symptoms.
TREATMENT. In all cases this is by radiotherapy. Results obviously depend
upon the extent of the growth when first diagnosed, and are not good in
advanced cases. As in other situations, sarcomata respond rapidly at first but
recurrence is common, and cytotoxic drugs may be given systemically in such
PROGNOSIS. This varies with the spread of the tumour when first treated,
About one third of the patients survive for 4 years.